WO2014128301A1 - Ponction dirigée par des ultrasons à détection optique - Google Patents

Ponction dirigée par des ultrasons à détection optique Download PDF

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Publication number
WO2014128301A1
WO2014128301A1 PCT/EP2014/053560 EP2014053560W WO2014128301A1 WO 2014128301 A1 WO2014128301 A1 WO 2014128301A1 EP 2014053560 W EP2014053560 W EP 2014053560W WO 2014128301 A1 WO2014128301 A1 WO 2014128301A1
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WIPO (PCT)
Prior art keywords
optical
ultrasound
needle
puncture
probe
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Application number
PCT/EP2014/053560
Other languages
German (de)
English (en)
Inventor
Bernd Meier
Original Assignee
Bernd Meier
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Bernd Meier filed Critical Bernd Meier
Priority to DE112014000968.7T priority Critical patent/DE112014000968A5/de
Publication of WO2014128301A1 publication Critical patent/WO2014128301A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
    • A61B8/0833—Detecting organic movements or changes, e.g. tumours, cysts, swellings involving detecting or locating foreign bodies or organic structures
    • A61B8/0841—Detecting organic movements or changes, e.g. tumours, cysts, swellings involving detecting or locating foreign bodies or organic structures for locating instruments
    • G—PHYSICS
    • G09—EDUCATION; CRYPTOGRAPHY; DISPLAY; ADVERTISING; SEALS
    • G09B—EDUCATIONAL OR DEMONSTRATION APPLIANCES; APPLIANCES FOR TEACHING, OR COMMUNICATING WITH, THE BLIND, DEAF OR MUTE; MODELS; PLANETARIA; GLOBES; MAPS; DIAGRAMS
    • G09B23/00—Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes
    • G09B23/28—Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes for medicine
    • G09B23/285—Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes for medicine for injections, endoscopy, bronchoscopy, sigmoidscopy, insertion of contraceptive devices or enemas
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/44—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device
    • A61B8/4438—Means for identifying the diagnostic device, e.g. barcodes

Definitions

  • the ultrasound-guided puncture of vessels, nerves, and organ tissues requires a lot of experience and practice in addition to knowledge of the anatomical location of the puncture target.
  • the surgeon performing the puncture must place the position of the puncture needle over the body surface in a spatial relationship with the two-dimensional image of the target angeled with the ultrasound probe. Since the ultrasound probe is usually guided by left-handed people with the right hand and the puncture needle with the left hand (vice versa), the ultrasound image presented by one hand must be well coordinated with the other hand guiding the puncture needle. This coordination can - as known from learning two-handed to playing musical instruments - can be achieved safely only by a lot of practice. This means that inexperienced significantly more Fehlticianionen and organ injuries occur than experienced.
  • the knowledge of puncture strategies and anatomical approaches required by ultrasound punctures can be acquired through frequent sonography of the affected body regions and through appropriate anatomical dissection exercises in the course of courses in anatomical institutes.
  • the practical exercise of the ultrasound-navigated puncture is left to the experiment on humans, probably under the supervision of an experienced teacher and is burdened here even with corresponding failed attempts.
  • doctors are increasingly demanding risky punctures in critically ill patients, without providing them with appropriate training and practice in this area.
  • the present method is intended to provide the necessary capabilities to perform an ultrasound-guided puncture without resorting to an appropriate method of treating a human or animal body with all risks.
  • Recent ultrasound-guided puncture procedures can locate the position of a puncture needle in the working space of the navigated puncture in front of an ultrasound probe by electromagnetic or optical means.
  • May et al. describe a navigation system in which the position of the needle tip is detected by an electromagnetic marking probe inserted into it by means of electromagnetic sensors on the ultrasound probe.
  • the position of the puncture needle is measured and calculated in this method, especially after penetration into the body.
  • Other methods optically capture the puncture needle using camera systems (Chan, C, Lam F, Blank R (2005) and Najafi, M; Rohling R (2011)).
  • the position of puncture needles marked at at least two locations is calculated by means of two spaced-apart camera systems. For this purpose, the puncture needle should be clearly marked on at least two sufficiently widely spaced points.
  • the camera systems spaced apart from one another do not display an image of the puncture needle in the working space in front of the ultrasound probe which can be obtained directly by the surgeon on the ultrasound image. Therefore, the surgeon always has to rely solely on the calculated projection lines in these procedures. Especially in practice procedures is a projection-oriented direct Visualization of the puncture needle in the plane of Ultraschalllotung and thus safe control and coordination by the practitioner desired.
  • the aim of the invention is to provide the trainee with an exercise device that provides a direct axis and projection view of a clean needle located in the working space in front of the ultrasound probe, starting from the trajectory of the random projection and penetration depth in the ultrasound image and all by a puncture corresponding Depth-triggered changes in the sound image can be selectively displayed and simulated without a puncture or injury actually taking place.
  • FIG. 1 illustrates the spatial situation of an ultrasound-navigated puncture in a three-dimensional Cartesian coordinate system, to which all the information used in the following refers.
  • the line through which the sound of the sonic probe S placed on the body surface enters the tissue of the arm is referred to below as the x-axis, the direction in which the ultrasound propagates into the depth of the tissue as the z-axis, the sounding ,
  • the Y-axis of the coordinate system of the Schalllotung extends at right angles to the X and Z axis in the working space in front of the ultrasound machine, in which the Exerziernadel is located.
  • the method of the invention is defined by claim 1.
  • the apparatus of the invention is defined by each of the independent apparatus claims.
  • the invention is based on the idea of ultrasonically directing precise puncturing with a puncture needle without puncturing a surface.
  • an exercise device is provided which is provided with a relative to a handle translationally movable puncture needle.
  • the puncture needle may be blunt and / or solid to avoid injury.
  • the puncture needle is placed on a surface, for example, the body surface of a subject. Alternatively, any other type of surface is conceivable because no puncture is to take place.
  • the handle is displaced in the distal direction along the needle over the latter in the direction of the surface.
  • the handle is thereby displaced along an axis which is determined by the location of the placement of the needle on the surface and the angle of the needle relative to the surface.
  • This axis is referred to below as the stitch axis, but without a puncture takes place in the surface.
  • stitch axis is intended to illustrate that the puncture is to be simulated in the area below the surface.
  • two optical systems are provided as part of an optical detection system.
  • the two optical systems conventionally receive visible light using at least one optical camera / image sensor.
  • optical mirrors may be provided to suitably reflect the light to be picked up in the direction of the camera.
  • the invention is based on the idea that both optical systems are spaced apart from each other and each fixedly connected to the ultrasound probe and take part of the exercise device / the puncture needle.
  • the needle is picked up by each of the two optical systems from a different direction.
  • the orientation of the two optical systems will be explained using the term "center beam”.
  • the term “midpoint beam” designates the central beam path of the incident light on the respective optical system.
  • the first optical system is aligned parallel to the axis with respect to the sounding direction (sound propagation direction of the ultrasonic probe), see above that a projection of the needle is recorded in the sound locating plane.
  • This image serves to project the needle into the plane of the ultrasound image.
  • the sound locating plane / plane of the ultrasound image is referred to herein as X / Z plane, where Z denotes the direction of sound propagation (depth direction) and the X direction denotes the width direction of the ultrasound image.
  • a projection of the needle is recorded in the plane of the ultrasound image.
  • This projection is preferably drawn as a line in the recorded ultrasound image.
  • the inclination angle of the stitch axis with respect to the surface in the Y direction is unknown.
  • the penetration depth is unknown, because a puncture does not occur.
  • the second optical system is aligned with respect to the first optical system and the ultrasonic probe such that the center beam of the second optical system detects a known sector of the working space in front of the ultrasonic probe detected by the first optical system.
  • the detected sector may be determined, for example, by a suitable calibration method or by knowing the angle and distance of the second optical system with respect to the first optical system.
  • the inclination of the needle with respect to the surface in the Y-direction perpendicular to the X-direction and the Z-direction is then determined. Furthermore, at least one point of the puncturing axis is determined with the aid of the second optical system.
  • the penetration depth can be determined, in which the exercise device, the needle or the handle part is provided with a marking body whose distance from the surface or the puncture site or the distal end of the puncture needle is evaluated as an indication of the penetration depth of the simulated puncture.
  • the second optical system is formed as a stereoscopic system which detects the same sector from different directions.
  • the second optical system may, for example, have mutually inclined mirrors or lenses that direct the light onto a common camera or lens throw a common image sensor.
  • two mutually inclined cameras / image sensors are conceivable.
  • the term camera is preferably understood to mean a digital image sensor.
  • the method according to the invention makes it possible to simulate an ultrasound-navigated puncture by using: a device referred to below as an Exerziernadel and paraphernalia, and an ultrasound navigation system, the Exerziernadel and paraphernalia in the plane of Schalllotung right-axis and at the correct distance to the sounded structures on the ultrasound image directly images and Starting from this figure, the trajectory of the stitch projection is displayed clearly.
  • FIG. 1 shows a perspective view of a first embodiment
  • Figure 2 shows another embodiment
  • Figure 3 is a section, a perspective view and a top view of
  • FIG. 4 is a perspective view of a second embodiment
  • FIG. 5 shows the view from the direction of the arrow V in FIG. 4,
  • FIG. 6 shows the section along the line VI-VI in FIG. 4,
  • FIG. 7 shows the section along the line VII-VII in FIG. 6,
  • FIG. 8 shows the section along the line VIII - VIII in Figure 5
  • 9 shows an embodiment of an exercise device in a first position
  • Figure 2 shows an exemplary embodiment of an Exerziernadel invention and a paring cutlery.
  • a puncture needle performing pin that can be placed as Exerziernadel EN on the body surface of the subject without injuring them or penetrate into the body, a device, the leading, attached to the body surface parts of this pin EN on approach of the paring utensils EB to slide back to the puncture target in the rear parts of the device ( Figure 2, below with extended Exerziemadel, Fig.2 top right with pushed into the drill bits Exerziemadel), an injection syringe or another implement performing essay, which is installed in the paring utensils is ( Figure 2 syringe stamp ST), a device that can influence the mechanical resistance in the back sliding of the leading parts of the tip of the Exerziernadel EN selectable in the rear parts of the drill set EB and so the tissue resistance at the puncture is TAI, in the drill built-in Mitt for simulating the handling of injections ST, means incorporated into the drill set, which can selectably influence the punch resistance during injections TA2, Incorporating means for simulating the
  • the paring utensil or the Exerziernadel from a pin with a deferred on this marker ball M which is advanced by the practitioner as a simulation of the puncture (with a paring utensil) forward in the direction of the puncture target.
  • the ultrasound navigation system according to the invention (FIG. 1, FIG. 3) is mounted on the ultrasound probe with a view of the working space of the puncture and contains: a first camera system Cl which precisely points the object points of the puncture needle onto the plane in which the sound signal is emitted spreads in the body as a stitch projection S (x, z) (Fig. L) receives, and a second camera system (lateral camera) C2 which laterally mounted next to the light entrance of the first camera system, the Exerziernadel and the marker body M in the working space in front of the ultrasonic probe from a lateral perspective maps.
  • a first camera system Cl which precisely points the object points of the puncture needle onto the plane in which the sound signal is emitted spreads in the body as a stitch projection S (x, z) (Fig. L) receives
  • a second camera system (lateral camera) C2 which laterally mounted next to the light entrance of the first camera system, the Exerziernadel and the marker body M in the working space in front of the ultras
  • the second camera system does not project the working space into the projection parallel to the axis of the center beam, but detects the angle in which a section or point of the Exerziernadel protrudes from the known center beam of the second camera system.
  • the angle wh with which the standing line of the Exerziernadel on the 2nd camera system of the X-axis of the coordinate system protrudes (A Scale for w is shown in the camera image of the second camera system in Fig.l top right).
  • this horizontal plane passes through the point corresponding to its center ray,
  • the trajectory of the drill string in the graph formed by the X- and Z-axes can be in the plane of the sound slot as the projection line S (x, z), and in the Y, and Z axes formed graphs as projection line S (y, z) are shown.
  • the stitch projection S (x, z) is located in the plane defined by the X-axis and the Z-axis sounding and therefore appears in the image of the needle by the first camera system as a straight section of the Exerziernadel, which by the computing unit in the ultrasound image is represented as an extension line in the coordinate system formed from X-axis and Z-axis.
  • the angle a is the angle of inclination of the stitch projection S (x, z) against the perpendicular (FIG. 1).
  • the corresponding angle of inclination of the needle in the image of the second (lateral) camera system corresponds to the angle j (FIG. 1).
  • Exerzierbesteck EB and Exerziernadel EN are located in the workspace of the ultrasonic navigation system, consisting of an ultrasonic probe (Fig.l) with the navigation system S, with the light input of the first camera system Cl and the light input of the second lateral camera system C2. Below the ultrasound probe is the angelotete puncture target T.
  • Exerziernadel EN and paring utensils EB and the ultrasonic navigation system are in the coordinate system of the Schalllotung, whose zero point is here below the light entrance of the center beam of the second lateral camera system C2.
  • the Z-axis runs in the beam direction of the sound probe (down).
  • the contact line of the sonic probe with the body surface through which the ultrasound signal enters the body corresponds to the X-axis of the coordinate system.
  • the Y axis extends at right angles to Z, and X axis extends forward into the working space.
  • the plane formed by the X- and Y-axis corresponds to the body surface of the working space on which the Exerziernadel EN is placed.
  • the lateral stitch projection is shown as the ray S (y, z) in the graph defined by Y and Z axes.
  • the stitch projection S (x, z) bottom, left detected by the first camera system is shown.
  • two sections C1 of the exerzi needle recorded by the first camera system are shown at a correspondingly correctly adjusted position.
  • the calculated trajectory of the stitch projection S (x, z) is shown for visualization and control as an extension of these directly imaged sections of the exericine needle both in the ultrasound image and in the camera image of the working space of the puncture.
  • the point of intersection of the stitch projection S (x, z) with the plane of the sound slot is shown here in the ultrasound image (> --- ⁇ ) in the region of the target T.
  • the marker ball M is illuminated by illuminants from the direction of the second camera system C2 (not shown in FIGS. 1 and 3) and thus highlighted. Since the trajectory of the stitch projection is known, the virtual depth of the simulated puncture can now be calculated from the image of the second camera system C2 (shown in FIG. 1, directly to the right of the navigation device) and displayed as line D in the ultrasound image.
  • FIG. 3 shows a device according to the invention for ultrasonic navigation.
  • a and B are deflecting mirrors which deflect 2 horizontal sections of the working space onto the camera C1.
  • the mirrors A and B are preceded by a Fresnel stage lens LI having a focal length which images the object points of the working space parallel to the center beam of the camera system onto the correspondingly spaced camera Cl.
  • a mirror W opposite the mirrors A and B advantageously deflects the image of the working space reflected by A and B onto the camera C1.
  • a further bifocally ground lens L2 is provided in the beam path of the portions of the working space reflected by the two mirrors A and B so that the different distances from A and B to the camera C1 are compensated with respect to the total focal length of the system.
  • the different distances between A and Cl and B and Cl can also be compensated by corresponding individual lenses which A and B are prefixed instead of LI.
  • the required by the first optical system focal length with a central axis parallel to the axis representation of the object points of the working space can also be achieved by installing correspondingly convex ground focal mirror instead planner deflecting mirrors and lenses. Further, correspondingly ground reflection prisms may be used instead of the mirrors and lenses to improve the optical performance of the camera system.
  • the first optical system visualizes the needle in the desired plane of the Schalllotung and outputs a direct image of the needle on the ultrasound image in this projection plane, from which then the calculated trajectory of the stitch projection as a superimposed line.
  • the puncturer can at any time check the quality of the calculated values of the trajectory of the stitch projection. If the drawn line of the stitch projection does not appear as a straight extension of the needle image, the values calculated for this plane are incorrect.
  • an additional marking of the puncture needle can be dispensed with.
  • the first optical system according to the invention provides all the points of the directly recorded exericine needle in the sound level as an X and Z coordinate.
  • the Y coordinate of one of these points and the angle j from the second lateral camera are needed. It turns out that this point can be easily determined by adjustment and calibration of the two optical systems - more precisely, the center beam of the second optical system.
  • the marking body M mounted on the paring utensil thus serves solely to calculate the simulated penetration depth. This property also showed surprising possibilities in the optical detection of other - not just running - geometric bodies when they are moved through the recording system.
  • the puncture artifacts displayed in the ultrasound image by the device according to the invention are:
  • Tissue injury bleeding, muscle contractions that can be triggered by injury or nerve stimulation.
  • tissue fluids from, for example, blood in paring utensils can be represented by incorporation and connection of appropriate display devices into the paring utensils by color change by using differently colored bulbs in the paring utensils.
  • the resistance to advancing the paring utensil can be changed depending on the tissue properties such as density, viscosity, elasticity and strength that can be derived from the ultrasound image.
  • the resistors which act counter to the syringe die of the drill when injecting or aspirating liquids, can be selectively influenced by using corresponding translational actuators TA 2, for example in an injection syringe, depending on the data detected by the sounding.
  • translational actuators TAI or TA2 hysteresis brakes or other electromechanical brake systems can be used as translational actuators TAI or TA2.
  • Both the data measured by the sensors and the control signals for the translational actuators can be provided by a cable connection be transmitted between the Exerziernadel and drill and the connected computer unit, which is connected to Cl and C2.
  • these signals can be transmitted as radio or light signals between the devices.
  • infrared LED bulbs can be used to transmit signals to the paring utensils, which are mounted as illuminants for illuminating the needle and the marking body on the locating device.
  • the illuminant may be connected to and controlled by the processor.
  • the inventive method allows injury-free practice of Ultraschallnavigationshabilit in humans.
  • the navigation device can be used in exercises on tissue models which have complex pathological anatomical structures. This uses fixed needles that are inserted into the tissue model. In these needles, a marking body M is mounted at the needle tip end of the needle in the region of the injection syringe cone such that the needle passes through the center of the marker body.
  • ultrasound-navigated punctures includes not only the coordination and handling of the paring utensils and the ultrasound probe, but also the sterile, contamination-free handling of the devices.
  • the ultrasound probe must be isolated from the disinfected area of the puncture site by a sterile sheath. In all manipulations, care should be taken to ensure that the probe covered with a sterile sheath and the puncture set are not contaminated by contact with non-disinfected objects.
  • the optical detection of the needle and the marking body must not be hindered by the envelope enclosing the ultrasonic probe.
  • the ultrasound probe is therefore enveloped by a sound-permeable casing which is well-permeable to the light emitted by the device according to the invention.
  • the sterile protective cover should fit tightly without wrinkling at the light entrance of the device.
  • the optical sharpness and intensity of the recorded images was very much dependent on the suction pressure built up by the pump.
  • Some very small openings between the Fresnel stages of these lenses cause the sleeve to be in an optimal position whereby the refractive properties are selectively influenced by changing the power of the suction pump.
  • the power of the suction pump can be easily controlled by the image processing processor, and the image quality can be optimized.
  • the device according to the invention requires a precise coordination of puncture needle, ultrasound device and the optical system for detecting the spatial position of the puncture needle.
  • the needle, ultrasound probe, and an optical calibration model are given a key code, some of which is known to the examiner.
  • radio tags such as RFID chips
  • the RFID chip is attached to the rear end of the Exerziernadel and slides when inserting the Exerziernadel in a covering sleeve within the paring cutlery, which interrupts a reading by a reader mounted on the sound probe depending on the sleeve position or releases.
  • the adjustment and calibration of sound probe and optical needle detection system serving opto-acoustic calibration body consists on one side of at least one embossed in a paper or a foil relief and hole structure, which is covered with at least one cover layer, which compared to the relief layer, a different acoustic impedance having.
  • This key can be sonographically implemented on the calibration body as part of the embossed relief structure or steganographically as part of the marking pattern.
  • the calibration is performed by placing the ultrasound probe on the relief, and imaging of the folded-up optical part of the calibration body by the first and second optical system according to the invention.
  • the structure of the sonographed relief changes as a function of the distance of the optical calibration pattern, so that after the analysis of the ultrasound image at different touchdown points on the pattern, an adjustment can be made with the differently spaced calibration pattern, in particular by the second optical detection system.
  • the keys of ultrasound device, navigation device and calibration model are merged by the computing unit generating a time-dependent feature.
  • the calibrated system is presented with the drill needle and its key, whereby a further time-dependent pairing of the data recorded in the navigation device and the Exerziernadel is generated with a time stamp that verifiably confirms the authenticity of the calibration data and all hereafter recorded images and data.
  • the keys preferably use asymmetric key pairs - private, which are used to create the pairings described, and public ones to verify the authenticity of the pairings. example
  • a 1.2 cm diameter retroflex marking body is drilled and attached to the syringe hub of a hypodermic syringe.
  • a 8.5 cm long steel tube the inside diameter of which receives a 18 gauge steel pin, is inserted into the needle hub of the syringe and passed through a corresponding hole in the syringe plunger to the rear.
  • In a 25 cm long and 6cm wide housing which is 1.5cm on one side and 6.6cm deep opposite on the 1.5cm deep side is a 5.5cm long and 1.9cm wide mirror as shown in Fig. 1 installed. The mirror has a slope from the back of 33 °.
  • a rail for the lens insert In front of the mirror is an opening (see Fig. L) and a rail for the lens insert. Small holes are drilled at regular intervals around the lens insert.
  • an electronic camera with a resolution of 1280x720 pixels, which has no infrared filter installed.
  • another electronic camera without infrared filter with view of the working space of the puncture is mounted in an adjusting device.
  • 6 holes are created in the housing in the 6 infrared LEDs installed and connected to a power source of the arithmetic unit.
  • a thin Fresnel stage lens with 6.5 dpt is inserted. Both camera systems are connected to the arithmetic unit.
  • the mirror and camera of the first electronic camera system are adjusted so that they record the working space in a projection perpendicular to the level of the ultrasound plumbing.
  • the axis-parallel representation of the object points of the working space by the first camera system is adjusted by changing the distance of the electronic camera to mirror and Fresnellecknlinse.
  • different calibration bodies are recorded at defined positions in the working space.
  • First and second camera systems are adjusted so that the center beam of the second lateral system is a horizontal row of those taken by the first camera system Object points in the work space and cuts their axis-parallel projection lines at an angle of 45 °.
  • the camera sections of this common series of points are stored in both the first and second camera systems.
  • a shell for fixed recording of an ultrasonic probe with a known distance to the light entrance of the first and second camera system is mounted.
  • An ultrasound probe is placed in the tray and attached.
  • Ultrasonic probe and navigation unit are placed in a protective cover.
  • a suction pump connected to the interior of the navigation unit is put into operation. It is noted that the shell rests tightly and wrinkle-free at the sound outlet and Fresnellecknlinse.
  • the image output by the ultrasound system is recorded by a third camera system and fed to the arithmetic unit.
  • the ultrasound probe is put into operation and placed at a defined location on a calibration model in which a sonographic detectable relief covered with a gel film is impressed.
  • the optical calibration body lying in the working space is slowly folded up.
  • the ultrasound image is displayed directly on a monitor.
  • the image of the working space taken by the first camera system is displayed above the ultrasound image. Its distance from the ultrasound image and its image size are calibrated by the optical calibration body where the dimensions and the distance to the end of the sound input of the ultrasound probe are known.
  • a puncture target is angeled in an ultrasound gel model. Exerziernadel and paring utensils are placed in front of the ultrasound probe. Above the ultrasound image, the image of the exergency needle recorded by the first camera system can already be used as a sighting line on the puncture target.
  • the graphic data analysis of the first and second camera systems now comprises the following steps.
  • the data of the second camera system consistent with the spatial angle is converted in the same way, taking into account the image function that satisfies the spatial angle.
  • the deviation angle of the calculated needle section to its center beam is calculated in the previously calibrated and calibrated common camera section. In this area, the 3dimensional space coordinates are calculated for exactly one point. From the averaging of the regression curves calculated for both camera systems, the complete 3-dimensional position of the needle can be represented starting from this point.
  • the height of the needle position is present. Above the ultrasound image, the Exerziernadelsent recorded by the first camera system is displayed. Starting from this, the stitching projection is drawn into the ultrasound image.
  • the point in the ultrasound image to which the stitch projection is aimed is displayed.
  • the puncture simulation is carried out by advancing the injection syringe with the mounted retroflex marking body in the direction of the angeled target.
  • the apparent penetration depth is calculated from the position of the retroflex marking body in the image of the second camera system.
  • a Nadeiartefakt is faded into the ultrasound image at the appropriate position.
  • the optical detection system S has two optical systems.
  • the first optical system comprises a Fresnel lens LI, a first deflection mirror A, a second deflection mirror W and an optical camera Cl.
  • the lens LI is part of the housing G of the optical detection system S, while the deflection mirrors A and W and the optical camera Cl are disposed within the housing G.
  • the second optical system has deflection mirrors Bl, B2, the deflection mirror W and the optical camera Cl.
  • the light collected by the deflecting mirrors and deflected in the direction of the camera Cl falls through a transparent window F of the housing G onto the mirrors B1, B2.
  • the two mirrors Bl, B2 are arranged inclined to each other and thereby throw a stereoscopic image on the lens of the camera Cl.
  • the camera Cl receives both the beam path deflected by the mirror A of the first optical system and the beam path deflected by the stereoscopic mirrors Bl, B2.
  • the information about the beam path S1 deflected by the first deflection mirror A of the first optical system and the second beam path S2 deflected by the stereoscopic mirrors B1, B2 are thus contained in the image data recorded by the camera C1.
  • the deflection mirrors A, Bl, B2 are arranged such that the light of each mirror is contained in another area of the image captured by the camera Cl.
  • the detection system S is provided with a receptacle on the lens LI and the window F opposite side of the housing G for an ultrasonic probe US.
  • the ultrasonic probe US can be firmly connected to the housing G, wherein the connection is advantageously solvable.
  • an infrared LED I is provided on the outside.
  • the LED I may be electrically connected to the processor, not shown in the figures, wherein the processor selectively drives the LED to enable / disable and / or control their intensity.
  • the infrared LED I serves to irradiate the needle EN or the marking body M, whereby the light reflected by the needle EN or the marking body M enters the housing of the optical detection system S through the lens LI or the window F and via the deflection mirrors, as shown in Figure 6, the camera Cl is supplied.
  • the optical filter K shown in FIG. 6 is preferably arranged in front of the camera C1 such that the incident light falls through the filter K onto the lens or the sensor of the camera C1.
  • the filter K is transparent to light in the infrared wavelength range, while blocking light with longer wavelengths. This can ensure that the camera Cl receives only infrared light, which is reflected in the inventive arrangement of the syringe (needle EN or marker body M), while other light sources, the automatic detection of the syringe needle EN or the marker body M in the captured image could be disturbed. It is conceivable to form the filter K from the camera Cl removably or pivotably within the housing of the optical detection system S.
  • Figures 9 and 10 show an embodiment of the exercise device.
  • Figure 9 shows the exercise device with the handle (drill bits EB) and with its front part - a pin (Exerziernadel EN) - before placing on a surface O.
  • the handle EB is at the distal, pointing in the direction of the surface O end with a Marking body M provided.
  • the marking body M is a light-reflecting ball. Alternatively, the marking body can also be an object emitting an electric and / or magnetic field.
  • the marking body M serves to determine the position of the exercise device with respect to the surface O. From this position, the penetration depth can be determined.
  • FIG. 10 shows the exercise device after placement on the surface O.
  • the pin EN (Exerziernadel) is placed on the puncture site T.
  • the handle EB is advanced over the Exerziernadel in the direction of the puncture site T, without the Exerziernadel thereby penetrates into the surface O. Rather, the Exerziernadel EN is moved through the opening P of the paring utensils EB through in the proximal direction to the rear out of the paring cutlery out.
  • the distal end of the Exerziernadel is dull and the Exerziernadel EN is solid to prevent penetration into the surface O.
  • a method for practicing ultrasonic-navigated punctures with an optical detection system mounted on a sound probe and a puncture needle performing exercise apparatus characterized in that a portion of the front surface of the exercise apparatus mounted on the body surface, over which a forwardly held in the direction of the puncture target held Handle part is pushed with a marking body from the rear, both by a first optical system which detects the object points of the working space in parallel projection to a selectable angle on the level of Schalilotung center beam, as well as by a second laterally adjacent to the first mounted optical system whose center beam detects a detected, represented by the first optical system sector of the working space, recorded and fed to a processor, wherein the recorded by the first system portion of the working device übe directly from the ultrasound image, on the basis of which the random projection in the plane of the sound slot, whose intersection with this plane of the sound slot, the simulated penetration depth and as simulated puncture artifacts needle tips, injectates and tissue changes in the ultrasound image are shown selectable.
  • a device for carrying out (1), a stylus EN, serving as a sharpening needle, a drill set EB which can be handled as a handle, and which has an opening and sliding device for receiving the exercial needle EN, a marker body M mounted over the exergency needle-housing opening such that the needle passes through the center of the marker body;
  • Electromechanical Actuators TAI which change the mechanical resistance, which counteracts the serving as a Exerziernadel pin when moving into the paraphernalia, selectable
  • Light detectors which are electrically connected in the paring utensil EB with a measuring amplifier, a processor unit, the electromechanical actuators and a power source.
  • Device for determining the position of a puncture needle in the working space of the ultrasound probe characterized in that at least a first mounted on the ultrasound probe camera system detects the object points in the working space in front of the ultrasound probe by optically reflective and refractive means in an axis-parallel projection to the center beam of his camera and an arithmetic unit which outputs the image in selectable position and dimension above the ultrasound image measured by the ultrasound probe and at least one second camera system mounted laterally next to the light entrance of the first camera whose midpoint beam passes through the workspace at a known angle to the center beam of the first camera system , picks up the puncture needle and supplies it to the arithmetic unit.
  • Device for displaying the object points of the working space in front of the ultrasound probe comprising: first electronic camera system, Deflection mirror, lenses and reflection prisms, which project the object points of the Häaums parallel to the axis of the center beam of the camera on the image converter, a second electronic camera system, mounted on the sound probe bulbs that illuminate the workspace with selectable light intensity and wavelength.
  • Device characterized in that sound probe and navigation device are inserted into a light and sound-permeable sterile sheath, which is sealed to the outside, and containing a tube open to the sound probe and navigation device with a connection to a suction device.
  • a calibration body at least one sonographically detectable relief is imprinted, which is covered with a layer which has a different acoustic impedance compared to the embossed relief layer, and adjacent to which an optical Sample having calibration body is located, the pattern of the arithmetic unit are known, or the arithmetic unit are made known via a key located on the calibration body.
  • the device comprising a computing unit which receives signals from the ultrasound probe and from the first and second optical camera systems, stores and controls illuminants on the navigation unit, wherein the image captured by the ultrasound probe and the image of the first optical system a view device in selectable distances and dimensions are displayed on top of each other, and are calculated from the image information of the camera systems, the coordinates of the position of puncture needles in front of the ultrasound probe, and a stitch projection with marking of the passage of the stitch projection through the plane of Ultraschalllotung and the simulated penetration depth are superimposed in the captured by the first camera system image and in the ultrasound image.

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Abstract

L'invention concerne un procédé et un dispositif pour pratiquer des ponctions dirigées par des ultrasons, comprenant une aiguille d'exercice, un instrument d'exercice et un dispositif pour déterminer la position spatiale de l'aiguille avant une sonde à ultrasons avec une visualisation directe de l'aiguille, la projection de piqûre résultante sous une forme superposée ainsi que d'autres paramètres dans l'image à ultrasons.
PCT/EP2014/053560 2013-02-25 2014-02-24 Ponction dirigée par des ultrasons à détection optique WO2014128301A1 (fr)

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DE112014000968.7T DE112014000968A5 (de) 2013-02-25 2014-02-24 Optisch erfasste ultraschallnavigierte Punktion

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DE102013003102.8 2013-02-25
DE201310003102 DE102013003102A1 (de) 2013-02-25 2013-02-25 Verfahren und Vorrichtung zur Übung ultraschallnavigierter Punktionen

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WO2017048929A1 (fr) * 2015-09-15 2017-03-23 University Of Florida Research Foundation, Incorporated Simulateurs d'introduction d'outil médical guidée par ultrasons
CN111028645A (zh) * 2019-11-13 2020-04-17 广州医科大学附属顺德医院（佛山市顺德区乐从医院） 一种提高超声穿刺精准度训练的装置
US11322048B2 (en) 2015-09-15 2022-05-03 University Of Florida Research Foundation, Incorporated Ultrasound-guided medical tool insertion simulators
CN115171464A (zh) * 2022-08-26 2022-10-11 首都医科大学宣武医院 一种可视化穿刺模具

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CN107862960B (zh) * 2017-09-08 2023-08-11 营口巨成教学科技开发有限公司 穿刺/插管医学教学模拟训练方法及所用的穿刺/插管训练系统

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Publication number Priority date Publication date Assignee Title
WO2017048929A1 (fr) * 2015-09-15 2017-03-23 University Of Florida Research Foundation, Incorporated Simulateurs d'introduction d'outil médical guidée par ultrasons
US11322048B2 (en) 2015-09-15 2022-05-03 University Of Florida Research Foundation, Incorporated Ultrasound-guided medical tool insertion simulators
CN111028645A (zh) * 2019-11-13 2020-04-17 广州医科大学附属顺德医院（佛山市顺德区乐从医院） 一种提高超声穿刺精准度训练的装置
CN115171464A (zh) * 2022-08-26 2022-10-11 首都医科大学宣武医院 一种可视化穿刺模具
CN115171464B (zh) * 2022-08-26 2024-05-03 首都医科大学宣武医院 一种可视化穿刺模具

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